| NPI | 1497140503 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 71109-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT209128) |
| 207Q00000X Family Medicine (Licence: KY 51558) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2021-11-24 |